open access

Vol 92, No 3 (2021)
Review paper
Published online: 2021-01-26
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Providing new insights into the endometriosisassociated cancer arising in episiotomy scars

Maria João Carvalho12, Ana Sofia Pais234, Ângela Rodrigues12, Ana Luísa Areia34, Margarida Figueiredo-Dias12
DOI: 10.5603/GP.a2020.0177
·
Pubmed: 33751518
·
Ginekol Pol 2021;92(3):220-225.
Affiliations
  1. Universitary Clinic of Gynecology, Faculty of Medicine, University of Coimbra, Azinhaga de Santa Comba, Coimbra, Portugal
  2. Gynecology Service, Coimbra Hospital and University Centre, Coimbra, Portugal
  3. Obstetric Department, Coimbra Hospital and University Centre, Coimbra, Portugal
  4. Faculty of Medicine, University of Coimbra, Coimbra, Portugal

open access

Vol 92, No 3 (2021)
REVIEW PAPERS Gynecology
Published online: 2021-01-26

Abstract

Endometriosis-associated malignancy in an episiotomy scar is rare. The predictive factors are poorly understood as are the mechanisms and pathways associated with implantation and malignant transformation. In this study we describe the cases reported in the literature of malignancies arising in endometriosis foci of an episiotomy scar. We identified 5 cases described between 1990 and 2016. These cases represent recurrence of endometriotic lesions in an episiotomy scar after previous diagnosis of endometriosis, 3 to 25 months before. Histology revealed clear cell tumours in 4 cases and a serous papillary carcinoma. The approach encompassed surgical removal for diagnosis and as part of the therapeutic strategy. Adjuvant treatment was performed depending on classical prognostic factors. Mechanisms of endometriosis implantation in scars include the influence of estrogens in the healing process and activation of COX-2, aromatase and matrix metalloproteinases. Nevertheless, for malignant transformation, other pathways seem to play a role, namely inflammation, immune response and oxidative stress, induced by iron deposits due to haemorrhage. Further studies are needed to allow the establishment of a predictive model for malignant transformation of endometriosis in episiotomy scars.

Abstract

Endometriosis-associated malignancy in an episiotomy scar is rare. The predictive factors are poorly understood as are the mechanisms and pathways associated with implantation and malignant transformation. In this study we describe the cases reported in the literature of malignancies arising in endometriosis foci of an episiotomy scar. We identified 5 cases described between 1990 and 2016. These cases represent recurrence of endometriotic lesions in an episiotomy scar after previous diagnosis of endometriosis, 3 to 25 months before. Histology revealed clear cell tumours in 4 cases and a serous papillary carcinoma. The approach encompassed surgical removal for diagnosis and as part of the therapeutic strategy. Adjuvant treatment was performed depending on classical prognostic factors. Mechanisms of endometriosis implantation in scars include the influence of estrogens in the healing process and activation of COX-2, aromatase and matrix metalloproteinases. Nevertheless, for malignant transformation, other pathways seem to play a role, namely inflammation, immune response and oxidative stress, induced by iron deposits due to haemorrhage. Further studies are needed to allow the establishment of a predictive model for malignant transformation of endometriosis in episiotomy scars.

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Keywords

endometriosis; episiotomy; malignancy; carcinogenesis

About this article
Title

Providing new insights into the endometriosisassociated cancer arising in episiotomy scars

Journal

Ginekologia Polska

Issue

Vol 92, No 3 (2021)

Article type

Review paper

Pages

220-225

Published online

2021-01-26

DOI

10.5603/GP.a2020.0177

Pubmed

33751518

Bibliographic record

Ginekol Pol 2021;92(3):220-225.

Keywords

endometriosis
episiotomy
malignancy
carcinogenesis

Authors

Maria João Carvalho
Ana Sofia Pais
Ângela Rodrigues
Ana Luísa Areia
Margarida Figueiredo-Dias

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